Abstract
The World Health Organization recommends point-of-use fortification with multiple micronutrients powder (MNP) for foods consumed by children aged 6-23 months in populations where anemia prevalence among children under 2 years or under 5 years of age is 20% or higher. In Rwanda, anemia affects 37% of children under 5 years. The MNP program was implemented to address anemia, but research on factors affecting the implementation of the MNP program is limited. We conducted a mixed-methods study to examine the factors influencing access to and use of MNP among mothers (N=379) in Rutsiro district, northwest Rwanda. Inductive content analysis was used for qualitative data. Logistic regression analysis was used to determine factors associated with the use of MNP. Qualitative results indicated that the unavailability of MNP supplies and distribution issues were major barriers to accessing MNP. Factors influencing the use of MNP included mothers' perceptions of side effects and health benefits of MNP, as well as inappropriate complementary feeding practices. Mothers of older children (aged 12-23 months) were more likely to use MNP than those of younger children (aged 6-11 months) (adjusted odds ratio [aOR]=3.63, P<.001). Mothers whose children participated in the supplementary food program were nearly 3 times more likely to use MNP than those whose children had never participated in the program (aOR=2.84, P=.001). Increasing household hunger score was significantly associated with lower odds of using MNP (aOR=0.80, P=.038). Mechanisms to monitor MNP supply and program implementation need to be strengthened to ensure mothers have access to the product. MNP program implementers should address gaps in complementary feeding practices and ensure mothers have access to adequate complementary foods.
Highlights
Inadequate intake of micronutrients is recognized as one of the most important contributors to the global burden of diseases.[1]
The data used in this study were collected as part of a survey conducted between September 2018 and January 2019 to investigate the factors associated with nutritional status of children aged 6–23 months
It is worth mentioning that our study found that some mothers who received micronutrients powder (MNP) still did not feed it to their children, so while receiving MNP is sometimes used as an indicator of program coverage, whether the child is consuming MNP according to the program recommended quantity and frequency, and not receiving it, may be a better indicator of program success.[21]
Summary
Inadequate intake of micronutrients is recognized as one of the most important contributors to the global burden of diseases.[1]. Anemia affects 70% of children aged 6–8 months and 64% of those aged 9–11 months.[6] other factors, such as parasite infections, may contribute to the high rates of anemia, evidence suggests that iron deficiency, resulting from inadequate dietary iron intake and/or low bioavailability and increased needs for iron during child growth, is a major cause.[7] As in many other low- and middle-income countries, Rwandan children consume predominantly plantbased diets, which contain low bioavailable iron.[8] A recent study conducted in Rwanda found that >60% of children aged 6–23 months do not meet their requirements for iron and other minerals such as calcium and zinc due to low nutrient density for these micronutrients in complementary foods.[9] The consumption of iron-rich foods, such as animal-source foods, and commercial fortified infant foods is low among children aged 6–23 months (20% and 2%, respectively).[5] As a consequence, it’s difficult for young children to meet their requirements for iron and other micronutrients during the critical development stages.[10]
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